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					                                   Advance Medical Directives
What Are Advance Medical Directives?
These documents could be a living will or a durable power of attorney for
health care (also called a health-care proxy). They allow you to give directions
about your future medical care. Having an advance directive is good for ev-
eryone young or old, since accidents and illness can strike at any time. It’s
your right to accept or refuse medical care. Advance directives can protect
this right if you become mentally or physically unable to choose or tell some-
one your wishes.


Deciding What You Want
Before making an advance directive, think about what’s important to you.
How would keeping or losing the ability to do things you value affect your
choice of treatment? Find out about all the treatments open to you. Then you
can decide the level of care that you would want. Advance directives can help you protect your right to make
medical choices, help your family avoid the stress of making hard decisions and help your doctor by giving him
guidelines for your care.


Recording Your Wishes
Once you know what level of medical care you want, you can protect your wishes by putting them in writing. With
an advanced directive, you can name someone else to make medical choices for you (durable power of attorney
for health care) or you can state the treatments you’d choose or not choose (living will).



                                    Living Will:                            Durable Power of Attorney:
                                    Explains your wishes in                 In writing, you can name a
                                    writing about your health               person (called a proxy) to
                                    care if you have a terminal             make decisions for you if
                                    condition. They are called              you become unconscious or
                                    “living” wills because they             mentally unable to decide.
                                    take effect while a patient is
                                    still alive.




  This information has been reviewed and recommended for use by the UAMS/CPED/Patient Education Advisory Committee.

                     UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
                      4301 West Markham Street - Little Rock, Arkansas 72205
Advance Medical Directives continued                                                                (Page 2 of 4)

Be Clear About What’s Important To You
Think about what’s important to you in life. This is the first step in deciding what medical care you’d want if you
were near death. Answer the questions below and talk about the answers with family and friends...
      How much do you value being able to do things on your own?
      How much do you value physical activity?
      What do you fear most about being ill or injured?
      Is it important for you to be physically, mentally or financially independent?
      How would you feel if you could no longer do things that you enjoy?
      How would you feel about being moved from your home?
      How would you feel about being cared for in a hospital or nursing home at the end of your life?




                                   It’s important for me to:

    die without pain                                                                 be able to make my
    and suffering                                                                    own decisions




    leave my family with                                                             not burden my family
    good memories




    act with my religious                                                            be with my loved
    beliefs                                                                          ones




  This information has been reviewed and recommended for use by the UAMS/CPED/Patient Education Advisory Committee.

                     UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
                      4301 West Markham Street - Little Rock, Arkansas 72205
Advance Medical Directives continued                                                                (Page 3 of 4)

Advance directives can limit life-prolonging measures when
there is little or no chance of recovery.
You may decide not to be put in the hospital if you are terminally ill or
permanently unconscious. You may decide against any treatments that will
not cure you. Advance directives can help you make known your feelings
about:
      Cardiopulmonary Resuscitation (CPR)
      When the heart stops (cardiac arrest), doctors and nurses use special
      measures to try and restart the heart. This may include massaging the
      heart, giving medicine, or using electrical shock.

      Intravenous (IV) therapy
      Can be used to provide food, water and or medicine through a tube
      placed in the vein.

      Feeding Tubes
      If you are no longer able to swallow food, your doctor may have you
      tube fed through your nose, your abdomen or intravenously (through
      the vein).

      Respirators (Artificial Breathing)
      Respirators are machines that breathe for you. In your Living Will, you can make it clear whether you want
      this kind of help or not.


                                           How Do I Create Advance Directives?
                                             Check the laws in your state regarding living wills and durable power
                                             of attorney for health care.

                                                Put your wishes in writing, and be as specific as you can be. You
                                                can complete and sign the forms attached to this handout.

                                                Sign and date your advance directive. You must have two adults,
                                                other than your health care worker, witness and sign the form be-
                                                fore it is legal.




  This information has been reviewed and recommended for use by the UAMS/CPED/Patient Education Advisory Committee.

                     UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
                      4301 West Markham Street - Little Rock, Arkansas 72205
Advance Medical Directives continued                                                                (Page 4 of 4)

What do I do with my Living Will and Healthcare Power of Attorney?
   Keep a card in your wallet stating that you have advance directives and where to find them.

      Give your doctor a copy to be kept as part of your medical records. If you use a durable power of attorney
      for health care, be sure to give a copy to the person who will be making decisions for you.

      Talk about your advanced directives with your family and friends. Give copies to a relative or friend who
      might be called in an emergency.

Review your advanced directives regularly and make changes as needed. Tell your doctor, family and
friends about any changes you make.


Questions and Answers About Advance Directives:
 1. Who is qualified to make an advance directive?
       a patient who can make decisions and understand the impact of that decision on treatment
       an adult age 18 or older
       an emancipated minor
      An advance directive will be honored if:
         the patient is 18 years of age or older
         the patient has declared his wishes or appointed a health care proxy
         a doctor has diagnosed a terminal condition or a permanently unconscious state

 2. What if I change my mind?
    You can change or cancel your advance directive at any time. Make sure you tell your doctors, health care
    workers, hospital and friends that your wishes have changed. Ask them to tear up and destroy old copies.

 3. What can be done if my wishes are not being carried out?
    You should talk with your doctor first. If it is not resolved at this point, talk with the nurse, social workers
    and/or chaplain.

Your Living Will and Healthcare Power of Attorney involve some of life’s most important choices. Don’t put off
asking for help. Talk to your doctor about any questions or ask him to refer you to someone who is qualified to
help. For more information you can contact:
    Partnerships for Caring
    200 Varick Street, 10th Floor
    New York, NY 10014
    1-800-989-WILL (9455)
    http:\\www.partnershipforcaring.org



  This information has been reviewed and recommended for use by the UAMS/CPED/Patient Education Advisory Committee.

                     UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
                      4301 West Markham Street - Little Rock, Arkansas 72205
Instructions For Using This Document
This document includes a Living Will, Healthcare Proxy and Optional Organ and Tissue Donation form. You can
fill out any or all of the forms. Make any changes you want. Then sign in front of two witnesses. If you want the
Living Will, Healthcare Proxy and Optional Organ and Tissue Donation you must sign this document in three
places. The document does not have to be notarized.

          Living Will Declaration                                            Healthcare Proxy
By                                                            Anytime I am temporarily or permanently unable to make
_________________________________________                     healthcare decisions, my healthcare proxy shall be:
(Name of person signing document)                             _________________________________________
                                                              (Name of person)
If I am terminally ill or permanently unconscious, and I
am not able to make decisions about my medical                My healthcare proxy may make all decisions about:
treatment, I direct my physician to withhold or                  My personal care
withdraw treatment that prolongs the process of my               My medical care
dying and is not necessary to my comfort. Specifically,          Hospitalization
if I am terminally ill or permanently unconscious, I direct      Whether I shall receive medical treatment or
my physician to withhold or withdraw treatment that only         procedures including artificial feeding or fluids,
prolongs the process of dying and is not necessary to my         even though I may die
comfort or to alleviate pain. This includes:                     Visitors, if problems arise concerning visits by friends
                                                                 and family
    antibiotics               breathing machine               Such decisions shall be consistent with my wishes, or, if
    surgery                   CPR                             my wishes are unknown, shall be consistent with my
    blood products            kidney dialysis                 best interest.
    nutrition/hydration
                                                              This document is intended to be a durable power of
                                                              attorney under A.C.A. 20-13-104 and a declaration and
This document is intended to be a Living Will under the       proxy statement under the Rights of the Terminally Ill or
Arkansas Rights of the Terminally Ill or Permanently          Permanently Unconscious Act.
Unconscious Act.
                                                              You may add further instructions here:
                                                              _______________________________________
Signed this ____day of _______________, 20____                _______________________________________
                                                              _______________________________________
________________________________________
Signature of person
                                                              Signed this ____day of _______________, 20____

                                                              ________________________________________
Witnesses                                                     Signature of person
The declarant voluntarily signed this writing in my
presence.
                                                              Witnesses
________________________________________                      The declarant voluntarily signed this writing in my
Signature of Witness                                          presence.
________________________________________                      ________________________________________
Address
                                                              Signature of Witness
                                                              ________________________________________
                                                              Address
                            Optional Organ and Tissue Donation

I, ________________________________________ do hereby authorize the donation for transplantation and/
 (Name of person signing document)

or medical research the following anatomical gifts:


       Body                      Liver

       Bone                      Lung

       Eyes                      Pancreas

       Heart                     Skin

       Heart Valves              All of the Above

       Kidneys                   Other_______________________

I further consent to the removal of any blood and tissue samples needed for lab tests. I also consent for the
Procurement Coordinator and physicians to have access to medical records related to the donation.


____________________________________________________________________________________
  Signature of person

____________________________________________________________________________________
 Address

Signed this________day of_____________________________________________________, 20________

				
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